The Affordable Care Act is now in serious, if not critical, condition. On a conceptual level, the pieces still make sense. But if the mechanics don’t start working soon, political support will flat-line. Nervous Democrats are already looking for cover — and Republicans are renewing their efforts to swing the wrecking ball. The law may not survive another serious body blow.

And honestly, Obama’s Thursday announcement that insurance companies can continue substandard plans for current policyholders for another year looks as much like deflection as it does correction. What the president has done is swat the bungled ball into the insurance companies’ court. Expect confusion to ensue as companies and customers scramble to make decisions about how to proceed.

Meanwhile, Obama’s one-year reprieve underlined another trust-eroding reality. It’s now apparent that the ACA cannot deliver on the president’s oft-repeated promise that anyone who likes his or her health insurance can keep it. Not on a permanent basis, anyway.

“I don’t think there is anything to do here to fix that,” says MIT economist Jonathan Gruber, who helped in the design of both Romneycare and Obamacare.

Why not? Because the price of the health plans offered on the exchange assumes that millions of people with substandard plans will upgrade to insurance that meets the ACA’s coverage standards. But if healthier people stay out of the more comprehensive plans while sicker people flock to them, those premiums will necessarily rise.

“Allowing the continuation of truly substandard policies while opening up the choice of much richer benefits would attract the sicker people into the new, larger risk pools, and that would therefore raise rates,” notes Jon Kingsdale, who ran the Massachusetts Health Connector for four years. Queried on risk pools and rate impacts during a conference call Thursday, White House officials talked vaguely about adjustment based on “risk corridors,” apparently a way of suggesting the government could help offset financial shortfalls insurers experience because of Obama’s new policy.

As for the president, he again expressed his regret and frustration, repeating “that’s on me” several times when speaking of the snafus. And yet his was such a low-energy performance that at times it bordered on the phlegmatic.

The president needs to tackle this head on, in a high-profile way, rather that acting as though these are mere bumps in the road. He needs to start by apologizing, fully and sincerely and with no qualifications, for leading people down the primrose path. Not at a rally. Not at a press conference. In a prime-time address.

There, he needs to do something that this administration has failed to do in a clear, sustained, persuasive way: Explain why, despite the rocky roll-out, the false promise, the ongoing problems, this law should be a very good thing for the country.

That must include outlining why the parts of the law that people don’t like are inextricably linked to the parts that they most appreciate. Years into this debate, too many still don’t understand that you can’t guarantee that people can get high-quality coverage despite any pre-existing conditions without also requiring that everyone buy insurance. Why not? Because if you have the guarantee of access to coverage without also mandating that everyone carry insurance, some will wait until they develop a serious illness before purchasing coverage. That obviously sets the entire notion of insurance on its ear. Premiums would skyrocket.

He should also make it clear that those who end up paying higher premiums will also be getting better policies and protections, protections that could save them crippling debt or even bankruptcy if they develop serious illnesses.

At a time when his own polling numbers are sinking and his signature law is under siege, the president needs to move beyond his no-drama Obama mode. This is not business as usual.

The president needs to move beyond his no-drama Obama mode. This is not business as usual.

Ideally, he would demonstrate the kind of compelling, high-energy leadership that could help reverse this frustrating narrative.

Failing that, it would nice if he could at least show more of a pulse.